Suicide in China - Underlying risk factors similar to western countries

November 28, 2002

Authors of a study in this week's issue of THE LANCET highlight that the underlying causes of suicide in China--a country with a high suicide rate--are similar to the causes reported in western populations, despite a substantially lower rate of mental illness among suicides in China (63% compared with 90% in western countries). The authors comment that public-health initiatives that target multiple risk factors for suicide are urgently needed to reduce suicide incidence in China.

Research published in THE LANCET earlier this year (Lancet 2002; 359: 835-40) estimated that 287,000 suicides occur in China each year, and identified suicide as the fifth most important cause of death in the country and the most important cause of death in young adults (aged 15-34 years). The same investigators, lead by Michael Phillips from the Beijing Suicide Research and Prevention Center and colleagues from the Chinese Centers for Disease Control and Prevention aimed to identify the major risk factors underlying the high incidence of suicide in China.

Family members and close associates of 519 people who committed suicide and 536 people who died from other injuries (the control group) from 23 locations around the country were interviewed to identify risk factors that could be linked to suicide. The 519 suicides were broadly representative of suicides throughout China: 52% were female; 84% lived in rural villages; 35% had never attended school; 62% died by ingesting pesticides or rat poison; 55% had relatives, friends, or associates who had had suicidal behaviour; 63% had a mental illness; and only 7% had ever seen a mental-health professional.

Eight significant risk factors for suicide were identified (after adjustment for sex, age, location of residence, and research site): high depression symptom score, previous suicide attempt, acute stress at time of death, low quality of life, high chronic stress, severe interpersonal conflict in the 2 days before death, a blood relative with previous suicidal behaviour, and a friend or associate with previous suicidal behaviour. Suicide risk increased substantially with exposure to multiple risk factors: none of the 265 deceased people who were exposed to one or fewer of the eight risk factors died by suicide, but 30% (90/299) with two or three risk factors, 85% (320/377) with four or five risk factors, and 96% (109/114) with six or more risk factors died by suicide.

Michael Phillips comments: "Despite substantial differences between characteristics of people who commit suicide in China and the west, risk factors for suicide do not differ greatly. Suicide prevention programmes that concentrate on a single risk factor are unlikely to reduce suicide rates substantially; preventive efforts should focus on individuals exposed to multiple risk factors."
Contact: Dr Michael R Phillips, Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing 100096, China (Peoples Republic);
T) 86-106-271-2471;
F) 86-108-295-1150;


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